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Darquenne C, Corcoran TE, Lavorini F, Sorano A, Usmani OS. The effects of airway disease on the deposition of inhaled drugs. Expert Opin Drug Deliv 2024:1-16. [PMID: 39136493 DOI: 10.1080/17425247.2024.2392790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/06/2024] [Accepted: 08/12/2024] [Indexed: 08/15/2024]
Abstract
INTRODUCTION The deposition of inhaled medications is the first step in the pulmonary pharmacokinetic process to produce a therapeutic response. Not only lung dose but more importantly the distribution of deposited drug in the different regions of the lung determines local bioavailability, efficacy, and clinical safety. Assessing aerosol deposition patterns has been the focus of intense research that combines the fields of physics, radiology, physiology, and biology. AREAS COVERED The review covers the physics of aerosol transport in the lung, experimental, and in-silico modeling approaches to determine lung dose and aerosol deposition patterns, the effect of asthma, chronic obstructive pulmonary disease, and cystic fibrosis on aerosol deposition, and the clinical translation potential of determining aerosol deposition dose. EXPERT OPINION Recent advances in in-silico modeling and lung imaging have enabled the development of realistic subject-specific aerosol deposition models, albeit mainly in health. Accurate modeling of lung disease still requires additional refinements in existing imaging and modeling approaches to better characterize disease heterogeneity in peripheral airways. Nevertheless, recent patient-centric innovation in inhaler device engineering and the incorporation of digital technology have led to more consistent lung deposition and improved targeting of the distal airways, which better serve the clinical needs of patients.
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Affiliation(s)
- Chantal Darquenne
- Department of Medicine, University of California, San Diego, CA, USA
| | | | - Federico Lavorini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandra Sorano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Omar S Usmani
- National Heart and Lung Institute, Imperial College London, London, UK
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Jin Z, Guo G, Yu A, Qian H, Tong Z. Comparative Analysis of Micrometer-Sized Particle Deposition in the Olfactory Regions of Adult and Pediatric Nasal Cavities: A Computational Study. Pharmaceutics 2024; 16:722. [PMID: 38931844 PMCID: PMC11206772 DOI: 10.3390/pharmaceutics16060722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Direct nose-to-brain drug delivery, a promising approach for treating neurological disorders, faces challenges due to anatomical variations between adults and children. This study aims to investigate the spatial particle deposition of micron-sized particles in the nasal cavity among adult and pediatric subjects. This study focuses on the olfactory region considering the effect of intrasubject parameters and particle properties. Two child and two adult nose models were developed based on computed tomography (CT) images, in which the olfactory region of the four nasal cavity models comprises 7% to 10% of the total nasal cavity area. Computational Fluid Dynamics (CFD) coupled with a discrete phase model (DPM) was implemented to simulate the particle transport and deposition. To study the deposition of micrometer-sized drugs in the human nasal cavity during a seated posture, particles with diameters ranging from 1 to 100 μm were considered under a flow rate of 15 LPM. The nasal cavity area of adults is approximately 1.2 to 2 times larger than that of children. The results show that the regional deposition fraction of the olfactory region in all subjects was meager for 1-100 µm particles, with the highest deposition fraction of 5.7%. The deposition fraction of the whole nasal cavity increased with the increasing particle size. Crucially, we identified a correlation between regional deposition distribution and nasal cavity geometry, offering valuable insights for optimizing intranasal drug delivery.
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Affiliation(s)
- Ziyu Jin
- School of Energy and Environment, Southeast University, Nanjing 210096, China; (Z.J.); (G.G.)
- Southeast University—Monash University Joint Research Institute, Suzhou 215123, China;
| | - Gang Guo
- School of Energy and Environment, Southeast University, Nanjing 210096, China; (Z.J.); (G.G.)
| | - Aibing Yu
- Southeast University—Monash University Joint Research Institute, Suzhou 215123, China;
- ARC Hub for Computational Particle Technology, Department of Chemical Engineering, Monash University, Clayton, VIC 3800, Australia
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing 210096, China; (Z.J.); (G.G.)
| | - Zhenbo Tong
- School of Energy and Environment, Southeast University, Nanjing 210096, China; (Z.J.); (G.G.)
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Aubriot AS, Maerckx G, Leal T, Gohy S, Reychler G. Comparison of amikacin lung delivery between AKITA® and eFlow rapid® nebulizers in healthy controls and patients with CF: A randomized cross-over trial. Respir Med Res 2023; 84:101038. [PMID: 37734235 DOI: 10.1016/j.resmer.2023.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Nebulization plays a key role in the treatment of cystic fibrosis. The Favorite function couple to jet nebulizers (AKITA®) emerged recently. The aim of this study was to assess the efficiency of the lung delivery by the AKITA® by comparing the urinary concentration of amikacin after nebulization with the AKITA® and the eFlow rapid®, in healthy subjects and patients with CF (PwCF). METHOD The two samples (healthy subjects and PwCF) were randomized (cross-over 1:1) for two nebulizations (500 mg of amikacin diluted in 4 mL of normal saline solution), with the AKITA® and with the eFlow rapid®. The primary endpoint was the amount of urinary excretion of amikacin over 24 h. The constant of elimination (Ke) was calculated based on the maximal cumulative urinary amikacin excretion plotted over time. RESULTS The total amount of urinary amikacin excretion was greater when AKITA® was used in PwCF (11.7 mg (8.2-14.1) vs 6.1 mg (3.7-13.3); p = 0.02) but not different in healthy subjects (14.5 mg (11.7-18.5) vs 12.4 mg (8.0-17.1); p = 0.12). The duration of the nebulization was always shorter with eFlow rapid® than with AKITA® (PwCF: 6.5 ± 0.6 min vs 9.2 ± 1.8 min; p = 0.001 - Healthy: 4.7 ± 1.3 min vs 9.7 ± 1.6 min; p = 0.03). The constant of elimination was similar between the two modalities in CF subjects (0.153 (0.071-0.205) vs 0.149 (0.041-0.182); p = 0.26) and in healthy subjects (0.166 (0.130-0.218) vs 0.167 (0.119-0.210), p = 0.25). CONCLUSION the Favorite inhalation is better to deliver a specific amount of drug than a mesh nebulizer (eFlow rapid®) in PwCF but not in healthy subjects.
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Affiliation(s)
- Anne-Sophie Aubriot
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, Cystic Fibrosis reference centre, Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium; Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Guillaume Maerckx
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium; Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Teresinha Leal
- IREC, Louvain centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium
| | - Sophie Gohy
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium; Cliniques universitaires Saint-Luc, Cystic Fibrosis reference centre, Université catholique de Louvain, Avenue Hippocrate 10, B-1200 Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Gregory Reychler
- Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Avenue Hippocrate 10, 1200 Brussels, Belgium; Secteur de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Service de Pneumologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium.
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Samuel J, Smaldone GC. Maximizing Deep Lung Deposition in Healthy and Fibrotic Subjects During Jet Nebulization. J Aerosol Med Pulm Drug Deliv 2019; 33:108-115. [PMID: 31855492 PMCID: PMC7133424 DOI: 10.1089/jamp.2019.1552] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In volunteers with idiopathic pulmonary fibrosis (IPF), inhaled Interferon-γ (IFN-γ) is safe and may improve pulmonary function. However, coughing, associated with upper airway deposition, is often reported. To address this problem, a small-particle, breath-enhanced jet nebulizer (i-NEB Mini; InspiRx, Inc., Somerset, NJ) was developed. Using gamma scintigraphy, this device was tested in healthy individuals and subjects with IPF to determine efficiency and regional deposition in lung and airways. Methods: Four healthy individuals and nine subjects with IPF were enrolled. The nebulizer was filled with 2 mL of saline with 99m Tc bound to diethylenetriaminepentaacetic acid (DTPA) powered continuously with 3.4 L/min of compressed air. Mass median aerodynamic diameter (MMAD) was measured by cascade impactor. To maximize deposition in alveoli, inspiratory flow was limited by an inspiratory resistance incorporated into the nebulizer, resulting in a deep inspiration ∼6 seconds. The treatment was run to completion (10 minutes), and each subject underwent deposition imaging. Mass balance and regions of interest determined upper airway (measured by calibrated stomach activity) and regional lung deposition as a percent of pretreatment nebulizer charge. Results: Subjects tolerated the device with no complaints. MMAD (mean [geometric standard deviation]) = 1.04 [1.92] μm. Lung deposition (mean ± standard error, % nebulizer charge) in healthy subjects was 26.2% ± 1.83 and in IPF individuals 23.4% ± 1.60 (p = 0.414). Upper airway deposition was 1.4% ± 0.83 and 2.3% ± 0.48, respectively (p = 0.351), and 20.1% was lost during expiration. Central/Peripheral ratios were consistent in both groups, showing high peripheral deposition (1.32 ± 0.050, vs. 1.28 ± 0.046, p = 0.912). Conclusion: The i-NEB Mini jet nebulizer with breath enhancement produced small particles, resulting in minimal upper airway deposition. Using slow and deep breathing, more than half of the emitted dose deposited in the peripheral lung in normal subjects and individuals with IPF. These data indicate that, for future clinical trials, controlled lung doses of small particles, designed to avoid coughing, are possible even in subjects with advanced disease.
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Affiliation(s)
- Joshua Samuel
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Gerald C Smaldone
- Pulmonary, Critical Care and Sleep Division, Department of Medicine, State University of New York at Stony Brook, Stony Brook, New York
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Carvalho TC, McConville JT. The function and performance of aqueous aerosol devices for inhalation therapy. ACTA ACUST UNITED AC 2016; 68:556-78. [PMID: 27061412 DOI: 10.1111/jphp.12541] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 02/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In this review paper, we explore the interaction between the functioning mechanism of different nebulizers and the physicochemical properties of the formulations for several types of devices, namely jet, ultrasonic and vibrating-mesh nebulizers; colliding and extruded jets; electrohydrodynamic mechanism; surface acoustic wave microfluidic atomization; and capillary aerosol generation. KEY FINDINGS Nebulization is the transformation of bulk liquids into droplets. For inhalation therapy, nebulizers are widely used to aerosolize aqueous systems, such as solutions and suspensions. The interaction between the functioning mechanism of different nebulizers and the physicochemical properties of the formulations plays a significant role in the performance of aerosol generation appropriate for pulmonary delivery. Certain types of nebulizers have consistently presented temperature increase during the nebulization event. Therefore, careful consideration should be given when evaluating thermo-labile drugs, such as protein therapeutics. We also present the general approaches for characterization of nebulizer formulations. SUMMARY In conclusion, the interplay between the dosage form (i.e. aqueous systems) and the specific type of device for aerosol generation determines the effectiveness of drug delivery in nebulization therapies, thus requiring extensive understanding and characterization.
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Affiliation(s)
- Thiago C Carvalho
- Bristol-Myers Squibb, Drug Product Science & Technology, New Brunswick, NJ, USA
| | - Jason T McConville
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, NM, USA
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Inhaled antimicrobial therapy – Barriers to effective treatment. Adv Drug Deliv Rev 2015; 85:24-43. [DOI: 10.1016/j.addr.2014.08.013] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/20/2014] [Accepted: 08/25/2014] [Indexed: 02/08/2023]
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Mukker JK, Singh RSP, Derendorf H. Pharmacokinetic and pharmacodynamic implications in inhalable antimicrobial therapy. Adv Drug Deliv Rev 2015; 85:57-64. [PMID: 25770775 DOI: 10.1016/j.addr.2015.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 02/14/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
Inhaled antimicrobials provide a promising alternative to the systemically delivered drugs for the treatment of acute and chronic lung infections. The delivery of antimicrobials via inhalation route decreases the systemic exposure while increasing the local concentration in the lungs, enabling the use of antimicrobials with severe systemic side effects. The inhalation route of administration has several challenges in pharmacokinetic (PK) and pharmacodynamic (PD) assessments. This review discusses various issues that need to be considered during study, data analysis, and interpretation of PK and PD of inhaled antimicrobials. Advancements overcoming the challenges are also discussed.
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Carrigy NB, Ruzycki CA, Golshahi L, Finlay WH. Pediatric in vitro and in silico models of deposition via oral and nasal inhalation. J Aerosol Med Pulm Drug Deliv 2015; 27:149-69. [PMID: 24870701 DOI: 10.1089/jamp.2013.1075] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Respiratory tract deposition models provide a useful method for optimizing the design and administration of inhaled pharmaceutical aerosols, and can be useful for estimating exposure risks to inhaled particulate matter. As aerosol must first pass through the extrathoracic region prior to reaching the lungs, deposition in this region plays an important role in both cases. Compared to adults, much less extrathoracic deposition data are available with pediatric subjects. Recently, progress in magnetic resonance imaging and computed tomography scans to develop pediatric extrathoracic airway replicas has facilitated addressing this issue. Indeed, the use of realistic replicas for benchtop inhaler testing is now relatively common during the development and in vitro evaluation of pediatric respiratory drug delivery devices. Recently, in vitro empirical modeling studies using a moderate number of these realistic replicas have related airway geometry, particle size, fluid properties, and flow rate to extrathoracic deposition. Idealized geometries provide a standardized platform for inhaler testing and exposure risk assessment and have been designed to mimic average in vitro deposition in infants and children by replicating representative average geometrical dimensions. In silico mathematical models have used morphometric data and aerosol physics to illustrate the relative importance of different deposition mechanisms on respiratory tract deposition. Computational fluid dynamics simulations allow for the quantification of local deposition patterns and an in-depth examination of aerosol behavior in the respiratory tract. Recent studies have used both in vitro and in silico deposition measurements in realistic pediatric airway geometries to some success. This article reviews the current understanding of pediatric in vitro and in silico deposition modeling via oral and nasal inhalation.
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Affiliation(s)
- Nicholas B Carrigy
- 1 Aerosol Research Laboratory of Alberta, Department of Mechanical Engineering, University of Alberta , Edmonton, Alberta, Canada T6G 2G8
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Kwok PCL, Chan HK. Delivery of inhalation drugs to children for asthma and other respiratory diseases. Adv Drug Deliv Rev 2014; 73:83-8. [PMID: 24270011 DOI: 10.1016/j.addr.2013.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/28/2013] [Accepted: 11/13/2013] [Indexed: 11/30/2022]
Abstract
Infants and children constitute a patient group that has unique requirements in pulmonary drug delivery. Since their lungs develop continuously until they reach adulthood, the airways undergo changes in dimensions and number. Computational models have been devised on the growth dynamics of the airways during childhood, as well as the particle deposition mechanisms in these growing lungs. The models indicate that total aerosol deposition in the body decreases with age, while deposition in the lungs increases with age. This has been observed on paediatric subjects in in vivo studies. Issues unique to children in pulmonary drug delivery include their lower tidal volume, highly variable breathing patterns, air leaks from facemasks, and the off-label or unlicensed use of pharmaceutical products due to lack of clinical data for this age group. The aerosol devices used are essentially those developed for adult patients that have been adapted to paediatric use. Facemasks should be used with nebulisers and spacers for infants and young children. An idealised throat that mimic the average particle deposition in paediatric throats has been designed to obtain more clinically relevant aerosol dispersion data in vitro. More effort should be spent on studying particle deposition in the paediatric lung and developing products specific for this subpopulation to meet their needs.
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Affiliation(s)
- Philip Chi Lip Kwok
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region.
| | - Hak-Kim Chan
- Faculty of Pharmacy, The University of Sydney, Camperdown, New South Wales 2006, Australia
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Dubus JC, Bassinet L, Chedevergne F, Delaisi B, Desmazes-Dufeu N, Reychler G, Vecellio L. Mucoviscidose et traitements inhalés : quoi de neuf en 2013 ? Rev Mal Respir 2014; 31:336-46. [DOI: 10.1016/j.rmr.2013.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/13/2013] [Indexed: 10/25/2022]
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Bakker EM, Volpi S, Salonini E, Müllinger B, Kroneberg P, Bakker M, Hop WCJ, Assael BM, Tiddens HAWM. Small airway deposition of dornase alfa during exacerbations in cystic fibrosis; a randomized controlled clinical trial. Pediatr Pulmonol 2014; 49:154-61. [PMID: 23913868 DOI: 10.1002/ppul.22800] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 02/14/2013] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Small airway obstruction is important in the pathophysiology of cystic fibrosis (CF) lung disease. Additionally, many CF patients lose lung function in the long term as a result of respiratory tract exacerbations (RTEs). No trials have been performed to optimize mucolytic therapy during a RTE. We investigated whether specifically targeting dornase alfa to the small airways improves small airway obstruction during RTEs. METHODS In a multi-center, double-blind, randomized controlled trial CF patients hospitalized for a RTE and on maintenance treatment with dornase alfa were switched to a smart nebulizer. Patients were randomized to small airway deposition (n = 19) or large airway deposition (n = 19) of dornase alfa for at least 7 days. Primary endpoint was forced expiratory flow at 75% of forced vital capacity (FEF75 ). MAIN RESULTS Spirometry parameters improved significantly during admission, but the difference in mean change in FEF75 between treatment groups was not significant: 0.7 SD, P = 0.30. FEF25-75 , FEV1 , nocturnal oxygen saturation and diary symptom scores also did not differ between groups. CONCLUSIONS This study did not detect a difference if inhaled dornase alfa was targeted to small versus large airways during a RTE. However, the 95% confidence interval for the change in FEF75 was wide. Further studies are needed to improve the effectiveness of RTE treatment in CF.
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Affiliation(s)
- E M Bakker
- Department of Paediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Breathing Resistance and Ultrafine Particle Deposition in Nasal–Laryngeal Airways of a Newborn, an Infant, a Child, and an Adult. Ann Biomed Eng 2012; 40:2579-95. [DOI: 10.1007/s10439-012-0603-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/22/2012] [Indexed: 12/31/2022]
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Bothra M, Lodha R, Kabra SK. Tobramycin for the treatment of bacterial pneumonia in children. Expert Opin Pharmacother 2012; 13:565-71. [PMID: 22292783 DOI: 10.1517/14656566.2012.656090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Common etiological agents for community-acquired lower respiratory tract infection (LRTI) include Streptococcus pneumoniae, Hemophilus influenzae and Mycoplasma pneumoniae and can be easily managed with oral or intravenous antibiotics. However, LRTI in patients with underlying illnesses, such as cystic fibrosis (CF) and immune deficiency, or on ventilator support is difficult to manage because these are caused by Gram-negative bacilli. Tobramycin has been shown to be effective in the management of these patients. AREAS COVERED Information about the antimicrobial activity, pharmacological aspects (including pharmacokinetics and pharmacodynamics), clinical efficacy, safety and side effects of tobramycin have been covered in this review. EXPERT OPINION A major advance for the use of tobramycin has occurred with its use by the inhalational route, in children with CF. The inhalation route provides the advantage of ease of administration for prolonged periods at home and allows use of very high doses. Systematic reviews suggest that tobramycin inhalation improves outcome, decreases the need for hospitalization and decreases the need for use of frequent systemic antibiotics in CF patients colonized with pseudomonas. Data on the efficacy of inhaled tobramycin in non-CF bronchiectasis are scarce, as are data on the prevention and treatment of ventilator-associated pneumonia, and on the role of combining inhaled tobramycin with systemic tobramycin. Despite limitations, this drug has the potential to be used in various conditions other than CF.
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Affiliation(s)
- Meenakshi Bothra
- All India Institute of Medical Sciences, Department of Pediatrics, New Delhi 110029, India
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Abstract
There are few reports of cystic fibrosis (CF) diagnosed in premature infants. We describe the clinical course of three patients, from our neonatal intensive care units, who were diagnosed with CF, and discuss the existing literature and treatment considerations.
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Affiliation(s)
- KD Lu
- Division of Pulmonary, Department of Pediatrics, John Hopkins University, Baltimore, MD, USA
| | - C Engmann
- Division of Neonatology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | - F Moya
- Division of Neonatology, Neonatal Intensive Care Unit at NHRMC, New Hanover Regional Medical Center, Wilmington, NC, USA
| | - M Muhlebach
- Division of Pulmonology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
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Koch K, Dew B, Corcoran TE, Przybycien TM, Tilton RD, Garoff S. Surface tension gradient driven spreading on aqueous mucin solutions: a possible route to enhanced pulmonary drug delivery. Mol Pharm 2011; 8:387-94. [PMID: 21250745 PMCID: PMC3070836 DOI: 10.1021/mp1002448] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Surface tension gradient driven, or "Marangoni", flow can be used to move exogenous fluid, either surfactant dispersions or drug carrying formulations, through the lung. In this paper, we investigate the spreading of aqueous solutions of water-soluble surfactants over entangled, aqueous mucin solutions that mimic the airway surface liquid of the lung. We measure the movement of the formulation by incorporating dyes into the formulation while we measure surface flows of the mucin solution subphase using tracer particles. Surface tension forces and/or Marangoni stresses initiate a convective spreading flow over this rheologically complex subphase. As expected, when the concentration of surfactant is reduced until its surface tension is above that of the mucin solution, the convective spreading does not occur. The convective spreading front moves ahead of the drop containing the formulation. Convective spreading ends with the solution confined to a well-defined static area which must be governed by a surface tension balance. Further motion of the spread solution progresses by much slower diffusive processes. Spreading behaviors are qualitatively similar for formulations based on anionic, cationic, or nonionic surfactants, containing either hydrophilic or hydrophobic dyes, on mucin as well as on other entangled aqueous polymer solution subphases. This independence of qualitative spreading behaviors from the chemistry of the surfactant and subphase indicates that there is little chemical interaction between the formulation and the subphase during the spreading process. The spreading and final solution distributions are controlled by capillary and hydrodynamic phenomena and not by specific chemical interactions among the components of the system. It is suggested that capillary forces and Marangoni flows driven by soluble surfactants may thereby enhance the uniformity of drug delivery to diseased lungs.
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Affiliation(s)
- Kevin Koch
- Physics Department, Carnegie Mellon University, Pittsburgh, PA 15213
- Center for Complex Fluids Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Beautia Dew
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
| | | | - Todd M. Przybycien
- Center for Complex Fluids Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Robert D. Tilton
- Center for Complex Fluids Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
- Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
- Department of Chemical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
| | - Stephen Garoff
- Physics Department, Carnegie Mellon University, Pittsburgh, PA 15213
- Center for Complex Fluids Engineering, Carnegie Mellon University, Pittsburgh, PA 15213
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Pitance L, Vecellio L, Leal T, Reychler G, Reychler H, Liistro G. Delivery Efficacy of a Vibrating Mesh Nebulizer and a Jet Nebulizer under Different Configurations. J Aerosol Med Pulm Drug Deliv 2010; 23:389-96. [DOI: 10.1089/jamp.2010.0816] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Laurent Pitance
- Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent Vecellio
- INSERM U618, Université Francois Rabelais de Tours, Aerodrug, Faculty of Medicine, Tours, France
| | - Teresinha Leal
- Clinical Chemistry Laboratory, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gregory Reychler
- Pediatric Respiratory Medicine & Cystic Fibrosis Unit, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Department of Physical Medicine and Rehabilitation, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Herve Reychler
- Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Giuseppe Liistro
- Respiratory Medicine, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Tiddens HAWM, Donaldson SH, Rosenfeld M, Paré PD. Cystic fibrosis lung disease starts in the small airways: can we treat it more effectively? Pediatr Pulmonol 2010; 45:107-17. [PMID: 20082341 DOI: 10.1002/ppul.21154] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The aims of this article are to summarize existing knowledge regarding the pathophysiology of small airways disease in cystic fibrosis (CF), to speculate about additional mechanisms that might play a role, and to consider the available or potential options to treat it. In the first section, we review the evidence provided by pathologic, physiologic, and imaging studies suggesting that obstruction of small airways begins early in life and is progressive. In the second section we discuss how the relationships between CF transmembrane conductance regulator (CFTR), ion transport, the volume of the periciliary liquid layer and airway mucus might lead to defective mucociliary clearance in small airways. In addition, we discuss how chronic endobronchial bacterial infection and a chronic neutrophilic inflammatory response increase the viscosity of CF secretions and exacerbate the clearance problem. Next, we discuss how the mechanical properties of small airways could be altered early in the disease process and how remodeling can contribute to small airways disease. In the final section, we discuss how established therapies impact small airways disease and new directions that may lead to improvement in the treatment of small airways disease. We conclude that there are many reasons to believe that small airways play an important role in the pathophysiology of (early) CF lung disease. Therapy should be aimed to target the small airways more efficiently, especially with drugs that can correct the basic defect at an early stage of disease.
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Affiliation(s)
- Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia, Rotterdam, the Netherlands.
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20
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Inhaled medication and inhalation devices for lung disease in patients with cystic fibrosis: A European consensus. J Cyst Fibros 2009; 8:295-315. [DOI: 10.1016/j.jcf.2009.04.005] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 04/05/2009] [Accepted: 04/08/2009] [Indexed: 12/12/2022]
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Abstract
BACKGROUND Inhaled drug delivery after lung transplantation provides a unique opportunity for direct treatment of a solid organ transplant. At present, no inhaled therapies are approved for this population though several have received some development. Primary potential applications include inhaled immunosuppressive and anti-infective drugs. OBJECTIVES The objective of this article is to review potential applications of inhaled medications for lung transplant recipients, the techniques used to develop inhaled drugs and the challenges of aerosol delivery in this specific population. METHODS The results of relevant studies are reviewed and two developmental examples are presented. RESULTS/CONCLUSIONS Inhaled medications may provide significant advantages for lung transplant recipients. Past studies with inhaled cyclosporine and amphotericin-B provide useful guidance for clinical development of new preparations.
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Affiliation(s)
- T E Corcoran
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, NW628 UPMC MUH, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
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22
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Zijlstra GS, J. Ponsioen B, A. Hummel S, Sanders N, Hinrichs WL, de Boer AH, Frijlink HW. Formulation and process development of (recombinant human) deoxyribonuclease I as a powder for inhalation. Pharm Dev Technol 2009; 14:358-68. [DOI: 10.1080/10837450802662820] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Minocchieri S, Burren JM, Bachmann MA, Stern G, Wildhaber J, Buob S, Schindel R, Kraemer R, Frey UP, Nelle M. Development of the premature infant nose throat-model (PrINT-Model): an upper airway replica of a premature neonate for the study of aerosol delivery. Pediatr Res 2008; 64:141-6. [PMID: 18391845 DOI: 10.1203/pdr.0b013e318175dcfa] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinical efficacy of aerosol therapy in premature newborns depends on the efficiency of delivery of aerosolized drug to the bronchial tree. To study the influence of various anatomical, physical, and physiological factors on aerosol delivery in preterm newborns, it is crucial to have appropriate in vitro models, which are currently not available. We therefore constructed the premature infant nose throat-model (PrINT-Model), an upper airway model corresponding to a premature infant of 32-wk gestational age by three-dimensional (3D) reconstruction of a three-planar magnetic resonance imaging scan and subsequent 3D-printing. Validation was realized by visual comparison and comparison of total airway volume. To study the feasibility of measuring aerosol deposition, budesonide was aerosolized through the cast and lung dose was expressed as percentage of nominal dose. The airway volumes of the initial magnetic resonance imaging and validation computed tomography scan showed a relative deviation of 0.94%. Lung dose at low flow (1 L/min) was 61.84% and 9.00% at high flow (10 L/min), p < 0.0001. 3D-reconstruction provided an anatomically accurate surrogate of the upper airways of a 32-wk-old premature infant, making the model suitable for future in vitro testing.
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Affiliation(s)
- Stefan Minocchieri
- Department of Paediatrics, Division of Neonatology, University of Bern, Inselspital, Bern, BE, Switzerland.
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Harris KW, Smaldone GC. Facial and ocular deposition of nebulized budesonide: effects of face mask design. Chest 2007; 133:482-8. [PMID: 18071018 DOI: 10.1378/chest.07-1827] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In vivo case reports and in vitro studies have indicated that aerosol therapy using face masks can result in drug deposition on the face and in the eyes, and that face mask design may affect drug delivery. OBJECTIVE To test different mask/nebulizer combinations for budesonide, a nebulized steroid used to treat pediatric patients with asthma. METHODS Using high-performance liquid chromatography, drug delivery (inhaled mass), facial, and ocular deposition of budesonide aerosols were studied in vitro using a ventilated face facsimile (tidal volume, 50 mL; rate, 25 breaths/min, duty cycle 0.4), a tight-fitting test mask, a standard commercial mask, and a prototype mask designed to optimize delivery by reducing particle inertia. Nebulizer insertion into the mask (front loaded vs bottom loaded) was also tested. Particle size was measured by cascade impaction. Pari LC Plus (PARI Respiratory Equipment; Midlothian, VA) and MistyNeb (Allegiance; McGaw Park, IL) nebulizers were tested. RESULTS Inhaled mass for tight-fitting and prototype masks was similar (13.2 +/- 1.85% vs 14.4 +/- 0.67% [percentage of nebulizer charge], p = 0.58) and significantly greater than for the commercial mask (3.03 +/- 0.26%, p = 0.005). Mask insertion of nebulizer was a key factor (inhaled mass: front loaded vs bottom loaded, 8.23 +/- 0.18% vs 3.03 +/- 0.26%; p = 0.005). Ocular deposition varied by an order of magnitude and was a strong function of mask design (4.77 +/- 0.24% vs 0.35 +/- 0.05%, p = 0.002, tight fitting vs prototype). Particle sizes (7.3 to 9 microm) were larger than previously reported for budesonide. CONCLUSIONS For pediatric breathing patterns, mask design is a key factor defining budesonide delivery to the lungs, face, and eyes. Front-loaded nebulizer mask combinations are more efficient than bottom-loaded systems.
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Affiliation(s)
- Keith W Harris
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York, Stony Brook, NY 11794-8172, USA
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26
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Finlay WH, Martin AR. Modeling of aerosol deposition with interface devices. ACTA ACUST UNITED AC 2007; 20 Suppl 1:S19-26; discussion S27-8. [PMID: 17411402 DOI: 10.1089/jam.2007.0554] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Various approaches can be used to mathematically model the performance of different masks, mouthpieces, and aerosol delivery devices. The sophistication of such models can vary widely, from the use of simple algebraic empirical correlations to advanced computational fluid dynamics simulations. Bench-top testing is also often used to model aspects of devices, since it is difficult to capture certain aspects of device behavior with mathematical models. These various approaches to modeling differ in their limitations. Empirical correlations exist for predicting the effects of varying mouthpiece diameter and mouth-throat dimensions on extrathoracic losses, but are restricted to stable, nonballistic aerosols in certain flow rate ranges. Computational fluid dynamics (CFD) simulations that solve the Reynolds-averaged Navier-Stokes (RANS) equations typically require near-wall turbulence corrections in order to adequately model mouth-throat deposition, while Large Eddy Simulation (LES) removes this deficiency. Bench-top models that use replicas of the extrathoracic airways vary in their accuracy and generality in replicating the filtering properties of these airways. Choosing and using these various modeling approaches for evaluating patient-device interfaces requires knowledge of their merits and pitfalls, a brief discussion of which is given here.
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Affiliation(s)
- W H Finlay
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada
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Brown VA, Wilkins PA. Advanced Techniques in the Diagnosis and Management of Infectious Pulmonary Diseases in Horses. Vet Clin North Am Equine Pract 2006; 22:633-51, xi. [PMID: 16882489 DOI: 10.1016/j.cveq.2006.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Techniques for novel approaches to the diagnosis and management of equine pulmonary disease continue to be developed and used in clinical practice. Diagnostic techniques involving immunoassays and nucleic acid-based tests not only decrease the time in which results become available but increase the sensitivity and specificity of test results. These assays do not substitute for careful clinical evaluation but can shorten the time to a confirmed accurate diagnosis, and thus allow for early initiation of therapeutic strategies and prevention protocols. With further understanding of the molecular biology and immunology of equine pulmonary disease, diagnostic and management techniques should become further refined.
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Affiliation(s)
- Valerie A Brown
- New Bolton Center, University of Pennsylvania School of Veterinary Medicine, 382 West Street Road, Kennett Square, PA 19348, USA.
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Abstract
Recognition of the importance of breathing pattern in aerosol delivery and deposition has led to the design of devices that allow targeting of deposition to airways and alveoli. Systems incorporating patient feedback provide control of factors affecting deposition, and the control of dose to the lung can now be expected. New devices combined with a medical realization of therapeutic need are beginning to affect the range of drugs now available to the caregiver or in development for the immediate future. The interface between the patient and the device represents a new area of practical research. Facemasks have been shown to be important in terms of drug delivery with different behavior in metered dose inhaler (MDI)/valved holding chambers compared to nebulizers. Recently completed clinical trials have demonstrated the usefulness of therapy targeted to the lungs in reducing systemic toxicity with enhanced efficacy. A prime example is aerosolized cyclosporine, used to prevent rejection in lung transplantation. This agent has recently been shown to reduce mortality in transplant recipients and will lead to a new drug application in the United States. For larger patient populations, the pursuit of therapies to reduce the incidence of ventilator-associated pneumonia (VAP) can affect the outcome of illness in the intubated patient in the Intensive Care Unit (ICU). Patients with idiopathic pulmonary fibrosis (IPF) may benefit from high doses of aerosolized interferon gamma. Patient and caregiver safety are additional factors that will affect future approaches to therapy.
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Affiliation(s)
- Gerald C Smaldone
- Pulmonary/Critical Care Division, Department of Medicine, Health Sciences Center, SUNY at Stony Brook, Stony Brook, New York 11794-8172, USA.
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Stites SW, Perry GV, Peddicord T, Cox G, McMillan C, Becker B. Effect of high-frequency chest wall oscillation on the central and peripheral distribution of aerosolized diethylene triamine penta-acetic acid as compared to standard chest physiotherapy in cystic fibrosis. Chest 2006; 129:712-7. [PMID: 16537872 DOI: 10.1378/chest.129.3.712] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND AND OBJECTIVES High-frequency chest wall oscillation (HFCWO) has been shown to be as effective as standard chest physiotherapy (SCPT) for removal of pulmonary secretions as well as increasing FEV(1) in cystic fibrosis (CF) patients. Patients using HFCWO often administer aerosolized medications simultaneously, reducing time required for daily care. While peripheral pulmonary distribution of tracer in normal subjects has been shown to be unaffected by HFCWO, this has not been studied in CF patients. We evaluated distribution of aerosolized (99m)Tc diethylene triamine penta-acetic acid (DTPA) administered simultaneously with HFCWO and compared this with DTPA aerosolized after SCPT. STUDY DESIGN Ten CF patients, ages 22 to 38 years, with moderate-to-severe obstructive disease were studied in a crossover design after documentation of stable lung function. (133)Xe was administered to delineate total lung volume. DTPA was aerosolized (Pari LC Plus nebulizer and Pulmo-Aide compressor; Pari Respiratory Equipment Inc.; Richmond, VA) to delineate airway deposition. The central to peripheral deposition ratio (C/P ratio) of each lung was analyzed in each study group. Central regions were represented by the inner one third of the (133)Xe scan as demonstrated in previous research models. RESULTS The mean C/P ratio (+/- SD) for both lungs was 1.45 +/- 0.31 with HFCWO and 1.46 +/- 0.28 following SCPT (p = not significant [NS]). Right lung mean C/P ratio was 1.74 +/- 0.43 with HFCWO and 1.85 +/- 0.63 after SCPT (p = NS). Left lung mean C/P ratio was 1.25 +/- 0.29 with HFCWO and 1.21 +/- 0.35 after SCPT (p = NS). There was no correlation between C/P ratio and FEV(1) or FVC. CONCLUSIONS Use of HFCWO in combination with aerosolized DTPA did not result in increased central deposition as compared with aerosolized DTPA administered after SCPT. Further study is required to determine if combining HFCWO with aerosolized medications can be modified to improve peripheral deposition.
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Affiliation(s)
- Steven W Stites
- Division of Pulmonary and Critical Care Medicine, University of Kansas Medical Center, Mail Stop 3007, Kansas City, KS 66160, USA.
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Köhler E, Sollich V, Schuster-Wonka R, Jorch G. Lung Deposition after Electronically Breath-Controlled Inhalation and Manually Triggered Conventional Inhalation in Cystic Fibrosis Patients. ACTA ACUST UNITED AC 2005; 18:386-95. [PMID: 16379615 DOI: 10.1089/jam.2005.18.386] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The present work aimed to investigate whether lung deposition can be improved by using a device that optimizes the breathing pattern through electronic control. The relative lung deposition was estimated by inhalation of the marker substance, sodium cromoglycate (SCG), and measurement of urinary excretion of SCG. Thirteen cystic fibrosis (CF) patients (aged 8-20 years) received 20 mg of SCG as nebulizer solution by means of (a) conventional inhalation (Parimaster + Pari LC Star nebulizer, manual interrupter) and (b) electronically breath-controlled inhalation (AKITA + Pari LC Star nebulizer). Inhalations were trained and supervised by a physiotherapist. Patients were asked to provide answers to a questionnaire about the convenience of electronically breath-controlled inhalation. Urine was collected in five fractions until 12 h p.a., and the excreted SCG was determined by means of high-performance liquid chromatography (HPLC). Following breath-controlled inhalation, the amount of SCG excreted in urine was significantly greater than after conventional inhalation (2.22 +/- 0.61 mg vs. 1.63 +/- 0.59 mg, p < 0.001). The absorption half-life for SCG following breath-controlled inhalation was significantly shorter when compared with conventional inhalation (78 +/- 23 min vs. 107 +/- 29 min; p < 0.01), suggestive of a more peripheral deposition for the former. Ninety-two percent of the patients judged that the electronically breath-controlled inhalation was good or very good. In conclusion, inhalation with an electronically optimized breathing pattern yields a greater and more peripheral lung deposition of SCG compared with the manually triggered conventional nebulizer technique in CF patients with several years of aerosol inhalation experience.
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Affiliation(s)
- Elke Köhler
- Department of General Paediatrics and Neonatology, Medical Faculty, Otto von Guericke University, Magdeburg, Wiener Strasse, Germany.
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Everard ML. Inhaler devices in infants and children: challenges and solutions. ACTA ACUST UNITED AC 2004; 17:186-95. [PMID: 15294070 DOI: 10.1089/0894268041457129] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mark L Everard
- Department of Respiratory Medicine, Sheffield Children's Hospital, Sheffield, United Kingdom.
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Schüepp KG, Straub D, Möller A, Wildhaber JH. Deposition of aerosols in infants and children. ACTA ACUST UNITED AC 2004; 17:153-6. [PMID: 15294065 DOI: 10.1089/0894268041457228] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is still a lack of knowledge in the field of aerosol therapy in children, particularly in young children. The amount of drug delivered from a commercially available inhalation device that reaches the lungs of children is generally low. The choice of an optimal combination of delivery device and drug formulation based on individual patient related factors is crucial. Aerosols with a small MMAD and a narrow GSD are required for a sufficient inhalation therapy in early childhood. The development of combinations of delivery devices and drug formulations fulfilling the requirements for an efficient inhalation therapy in young children is likely to increase the therapeutical options in this age group.
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Affiliation(s)
- Karen G Schüepp
- Swiss Paediatric Respiratory Research Group, Department of Respiratory Medicine, University Children's Hospital, Zurich, Switzerland
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Condos R, Hull FP, Schluger NW, Rom WN, Smaldone GC. Regional Deposition of Aerosolized Interferon-γ in Pulmonary Tuberculosis. Chest 2004; 125:2146-55. [PMID: 15189935 DOI: 10.1378/chest.125.6.2146] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Aerosol interferon-gamma (IFN-gamma) is a potential immunomodulator in the treatment of pulmonary tuberculosis (TB). Previous investigations demonstrated conversion of sputum smears in five patients with multidrug-resistant TB after 12 treatments over 1 month, and induction of signaling molecules in 10 of 11 drug-sensitive TB patients using BAL. The objective of the current study was to evaluate particle size and deposition pattern in patients with TB receiving aerosol IFN-gamma treatment. DESIGN Particle size was determined with a cascade impactor, and deposition of IFN-gamma mixed with (99m)Tc-labeled human serum albumin was assessed using a gamma camera. Local levels of IFN-gamma were measured in BAL using enzyme-linked immunosorbent assays. Study patients/intervention: Fourteen patients with pulmonary TB received IFN-gamma aerosol (500 micro g) for 12 treatments in addition to antimycobacterial therapy with BAL before and after IFN-gamma aerosol treatment. Eight patients with minimal-to-moderate parenchymal involvement underwent deposition studies. Deposited (99m)Tc-labeled IFN-gamma aerosol was partitioned between upper airways and lungs using attenuation correction measurements. (133)Xe equilibrium scanning, (133)Xe washout, and (99m)Tc- macroaggregate injection defined regional lung volume, ventilation, and perfusion. RESULTS Upper airway deposition was significant often exceeding lung deposition (53.9 +/- 7.09 micro g vs 35.8 +/- 2.73 micro g, respectively [mean +/- SE]). IFN-gamma levels measured in BAL fluid were significantly increased with aerosol treatment (0.83 +/- 0.43 micro g before vs 24.76 +/- 8.71 micro g after, p </= 0.017), and IFN-gamma levels correlated with regional deposition of IFN-gamma aerosol (r = 0.823). Four-quadrant analysis of regional lung deposition best correlated with regional perfusion (r = 0.422, p = 0.013) with penetration of aerosol into areas of obvious radiographic infiltration on chest radiograph. CONCLUSIONS Aerosol therapy with IFN-gamma in patients with pulmonary TB is widely distributed and results in significant enhancement of IFN-gamma levels in the lower respiratory tract. In patients without lung destruction, IFN-gamma aerosol may be an adjuvant to enhance the local immune response.
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Affiliation(s)
- Rany Condos
- Bellevue Chest Service, Division of Pulmonary and Critical Care Medicine, NYU School of Medicine, New York, USA.
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Sangwan S, Condos R, Smaldone GC. Lung Deposition and Respirable Mass During Wet Nebulization. ACTA ACUST UNITED AC 2003; 16:379-86. [PMID: 14977428 DOI: 10.1089/089426803772455631] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
For metered dose inhalers (MDIs), high-flow cascade impaction with a United States Pharmacopia (USP) throat provides a useful prediction of in vivo lung and oropharyngeal aerosol deposition. Particles expected to deposit in the lung are included in the "fine particle fraction" measured on the bench. Comparable in vitro standards are not available for nebulizers. The present study compared aerosol deposition in an in vitro model using low-flow cascade impaction with deposition in vivo in human subjects. A low-flow (1 Lmin), 10-stage cascade impactor measured aerodynamic distributions of aerosolized interferon-gamma (IFN-gamma) from two nebulizers (Misty-Neb and AeroEclipse). (99m)Technetium diethylene triaminepenta-acetic acid ((99m)Tc-DTPA) was used as the radiolabel. Two bench conditions were specified: no breathing (standing cloud) and simulated ventilation with a piston pump (tidal volume 750 mL frequency 25 per minute and duty cycle 0.5). Mass median aerodynamic diameter (MMAD) for both nebulizers was affected by ventilation (Misty-Neb vs. AeroEclipse: 5.2 vs. 4.6 microm for standing cloud and 3.1 vs. 2.2 microm during ventilation). In three subjects, measured values of oropharyngeal deposition averaged 68.1 +/- 0.08% for Misty-Neb and 30.9 +/- 0.03% for AeroEclipse. In vivo deposition patterns compared to aerosol distributions from both nebulizers indicated that, for wet nebulization, penetration of aerosol beyond the upper airways (fine particle fraction) will occur only for aerosol particles below 2.5 microm. This assessment requires that the bench aerosol distribution be measured under conditions of clinical use (i.e., during tidal breathing).
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Affiliation(s)
- Sanjay Sangwan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, State University of New York, Stony Brook, New York 11794-8172, USA
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Geller D, Thipphawong J, Otulana B, Caplan D, Ericson D, Milgram L, Okikawa J, Quan J, Bowman CM. Bolus inhalation of rhDNase with the AERx system in subjects with cystic fibrosis. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2003; 16:175-82. [PMID: 12823911 DOI: 10.1089/089426803321919933] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Inhaled recombinant human deoxyribonuclease (rhDNase) delivered by nebulizer improves pulmonary function and reduces the rate of pulmonary exacerbations in cystic fibrosis subjects. Standard jet nebulizers are relatively inefficient and require a delivery time of 10-20 min. We conducted an open-label, proof-of-concept study to evaluate whether bolus inhalation of rhDNase with a more efficient delivery system was safe and effective in cystic fibrosis subjects. The AERx system used for this study aerosolized 1.35 mg of rhDNase in three inhalations at a single sitting. The predicted AERx lung dose was approximately 0.68 mg, a dose consistent with lung doses of rhDNase given by jet nebulizer. In our 16 subjects with cystic fibrosis, a mean relative increase in FEV(1) of 7.8% (p < or = 0.001) was observed after 15 days of bolus delivery of rhDNase with the AERx system. The safety profile of rhDNase given as a bolus was similar to that observed with traditional nebulizer delivery. This study demonstrated that bolus inhalation of rhDNase was feasible, reasonably well-tolerated, and associated with improvement in pulmonary function in this small group of cystic fibrosis subjects.
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Affiliation(s)
- David Geller
- The Nemours Children's Clinic, Orlando, Florida 32806, USA.
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Grimbert D, Vecellio L, Delépine P, Attucci S, Boissinot E, Poncin A, Gauthier F, Valat C, Saudubray F, Antonioz P, Diot P. Characteristics of EPI-hNE4 aerosol: a new elastase inhibitor for treatment of cystic fibrosis. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2003; 16:121-9. [PMID: 12823906 DOI: 10.1089/089426803321919889] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to define nebulization conditions providing delivery of aerosols of EPI-hNE4, an inhibitor of human neutrophil elastase (HNE). EPI-hNE4 was nebulized with Pari LC Star and tested at three concentrations (2.5, 5, and 10 mg/mL). The inhaled mass was measured over 15 min. Particle size distribution was measured by cascade impaction. The effect was also tested of mixing EPI-hNE4 with a (99m)Tc human serum albumin (HSA) tracer on the aerodynamic properties of the aerosol. The inhibitory activity of EPI-hNE4 after nebulization was assessed on purified HNE. The inhaled mass was 32.3 +/- 3.5% (mean +/- SD) after 10 min and 44.2 +/- 3.8% (mean +/- SD) after 15 min. Mass median aerodynamic diameter ranged between 1.2 and 1.8 microm. The (99m)Tc HSA EPI-hNE4 aerosol was similar in terms of particle size distribution (y = 1.0338x - 0.003, r = 0.83). (99m)Tc activity was predictive of EPI-hNE4 mass distribution (y = 1.0278x - 1.6991, r = 0.89). The inhibitory capacity of aerosolized samples remained unchanged after up to 10 min of nebulization. EPI-hNE4 can be nebulized efficiently without decrease in its activity. Mixing this inhibitor with (99m)Tc HSA should allow quantification of its deposition in CF patients.
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Affiliation(s)
- D Grimbert
- INSERM EMI-U 00-10, IFR 120, Groupes de Pneumologie et Enzymologie, Tours, France
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Abstract
Delivering aerosolised drugs to infants poses a number of challenges. It is clear that drug delivery is possible via the inhaled route but to date it has been difficult to demonstrate clearly therapeutic benefit from the use of any conventional therapy in the vast majority of infants. This is probably related to the nature of pulmonary disease in this age group. While most aerosol scientists focus on factors such as aerosol size and airways geometry drug delivery, as in all age groups, is most dependent upon patient behaviour. A small amount of drug reaches the lungs of distressed infants. Consideration of patient device interactions is vital if successful drug delivery is to be achieved and this includes consideration of mask design. Doses reaching the lungs are generally very low when considered in terms of the nominal dose but when considered in terms of dose delivered per kilogram body weight drug delivery to the lungs is generally similar to or greater than in adults. Upper airways deposition is relatively greater than in older subjects, in large part because of nasal breathing, and this will affect the 'therapeutic index' of some drugs.
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Affiliation(s)
- Mark L Everard
- Department of Respiratory Medicine, Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK.
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Köhler E, Sollich V, Schuster-Wonka R, Hühnerbein J. Lung deposition in cystic fibrosis patients using an ultrasonic or a jet nebulizer. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2003; 16:37-46. [PMID: 12737683 DOI: 10.1089/089426803764928347] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study was conducted to compare pulmonary deposition following inhalation with an ultrasonic and a jet nebulizer in CF patients under conditions relevant to practice. The marker substance used to estimate the relative lung bioavailability was sodium cromoglycate (SCG), which is poorly absorbed from the gastrointestinal tract, but is completely absorbed from the lungs. Ten CF patients (aged 9-21 years) used an ultrasonic nebulizer (Multisonic compact 2.4 MHz) and a jet nebulizer (Parimaster, LC Plus Turbo) in a crossover design to inhale a solution containing 20 mg of SCG and a beta(2)-agonist. Urine was collected in five fractions until 12 h p. a., and the excreted SCG was determined by means of HPLC. Prior to each inhalation, the patients' pulmonary function was measured employing a Pneumoscope. Using the ultrasonic nebulizer, the amount of SCG excreted in urine was significantly greater than that after inhalation with the jet nebulizer (1.43 +/- 0.47 mg vs. 1.04 +/- 0.47 mg; p = 0.002), despite the larger residual volume in the ultrasonic nebulizer. The absorption half-life for SCG following ultrasonic nebulization was significantly shorter when compared with jet nebulization (84 +/- 14 min vs. 101 +/- 19 min; p = 0.005), being suggestive of a more peripheral deposition. Furthermore, an inverse relationship was found between absorption half-life and FEV(1) (% pred.) (r = -0.655, p = 0.04) or MMEF(75/25) (% pred.) (r = -0.844, p = 0.031), but only with the ultrasonic nebulizer. In conclusion, the ultrasonic nebulizer tested when used for inhalation in CF patients was found to be at least equivalent to the jet nebulizer.
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Affiliation(s)
- Elke Köhler
- Department of General Paediatrics and Neonatology, Medical Faculty, Otto von Guericke University, Magdeburg, Wiener Strasse, Germany.
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Geller DE, Rosenfeld M, Waltz DA, Wilmott RW. Efficiency of pulmonary administration of tobramycin solution for inhalation in cystic fibrosis using an improved drug delivery system. Chest 2003; 123:28-36. [PMID: 12527599 DOI: 10.1378/chest.123.1.28] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To determine whether tobramycin solution for inhalation (TSI) can be administered safely and more efficiently with a new-generation aerosol device, the AeroDose 5.5 RP inhaler (Aerogen; Mountain View, CA) than with the approved PARI LC PLUS nebulizer (PARI Respiratory Equipment; Monterey, CA) with Pulmo-Aide compressor (DeVilbiss Corp; Somerset, PA). Second, we wanted to ascertain which AeroDose-delivered tobramycin dose is equivalent to the standard 300-mg dose administered with the PARI LC PLUS. DESIGN Open-label, randomized, multicenter, single-dose, three-period, four-treatment, active- control, crossover trial. SETTING Nine US cystic fibrosis (CF) centers. PATIENTS Fifty-three patients >or= 12 years of age with a confirmed diagnosis of CF, the ability to expectorate sputum, and FEV(1) of >or= 40% of predicted. METHODS Subjects inhaled three single doses of TSI at 1-week intervals, as follows: conventional control treatment, 300 mg via the PARI LC PLUS; and two of three experimental treatments, 30, 60, or 90 mg via the AeroDose. FEV(1) was measured before and after dosing. After each dose, sputum and serum samples were collected at various intervals for 8 h, and urine was collected for 24 h to estimate lung and systemic tobramycin delivery. RESULTS There were no significant differences between treatments in the change in FEV(1) 30 min after dosing or in the frequency of adverse events. Sputum and serum levels of tobramycin produced by the AeroDose 90-mg dose treatment approximated those achieved with the PARI LC PLUS 300-mg dose treatment. Nebulization times using the AeroDose inhaler were < 50% those of the PARI LC PLUS. CONCLUSIONS Compared with the standard nebulizer, the AeroDose safely achieved an approximately threefold greater efficiency in the delivery of TSI to the lungs in less than half the time.
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Affiliation(s)
- David E Geller
- The Nemours Children's Clinic, 83 W Columbia St, Orlando, FL 32806-1101, USA.
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Corcoran TE, Chigier N. Inertial deposition effects: a study of aerosol mechanics in the trachea using laser Doppler velocimetry and fluorescent dye. J Biomech Eng 2002; 124:629-37. [PMID: 12596629 DOI: 10.1115/1.1516572] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study characterizes the axial velocity and axial turbulence intensity patterns noted in the tracheal portion of a cadaver-based throat model at two different steady flow rates (18.1 and 41.1 LPM.) This characterization was performed using Phase Doppler Interferometry (Laser Doppler Velocimetry). Deposition, as assessed qualitatively using fluorescent dye, is related to the position of the laryngeal jet within the trachea. The position of the jet is dependent on the downstream conditions of the model. It is proposed therefore that lung/airway conditions may have important effects on aerosol deposition within the throat. There is no correspondence noted between regions of high axial turbulence intensity and deposition.
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Corcoran TE, Dauber JH, Chigier N, Iacono AT. Improving drug delivery from medical nebulizers: the effects of increased nebulizer flow rates and reservoirs. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2002; 15:271-82. [PMID: 12396415 DOI: 10.1089/089426802760292618] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Drug delivery from jet nebulizers can be considered in terms of the dose inhaled and the respirability of that dose. It is proposed that dose respirability and dose per breath can be controlled through specification of the driving gas flowrate, and that the dose inhaled per breath can also be increased through the use of nebulizer reservoirs. When a Hudson Micromist nebulizer was used and assessments of respirability were made utilizing phase Doppler interferometry, it was noted that the portion of the spray mass in droplet sizes of <or=5 microm (general respirability) and in droplet sizes of <or=3 microm (deep lung respirability) increased linearly with gas flowrate for both tank air and helium-oxygen (70/30). Drug mass in the 2-6 microm range (tracheobronchial respirability) peaked at air flowrates of 8-10 LPM and decreased slightly for higher flowrates. Two portable compressors provided respirabilities similar to tank air at the same flowrates. Changing the nebulizer flowrate did not affect the ratio of the inhaled dose to the dose expelled by exhalation when a typical breathing pattern was simulated. A version of the Micromist with an attached reservoir (the Hudson AeroTee) provided a higher dose per breath to the patient and a higher total dose for the same treatment time by conserving the aerosol generated during exhalation. The inhaled dose increased approximately 28% when compared to a standard Micromist, despite significant deposition in the reservoir bag. Nebulizer reservoirs could be used to attain higher doses or to more efficiently utilize expensive medications.
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Affiliation(s)
- T E Corcoran
- Division of Pulmonary, Allergy, and Critical Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
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Deshpande D, Blanchard J, Srinivasan S, Fairbanks D, Fujimoto J, Sawa T, Wiener-Kronish J, Schreier H, Gonda I. Aerosolization of lipoplexes using AERx Pulmonary Delivery System. AAPS PHARMSCI 2002; 4:E13. [PMID: 12423062 PMCID: PMC2751352 DOI: 10.1208/ps040313] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The lung represents an attractive target for delivering gene therapy to achieve local and potentially systemic delivery of gene products. The objective of this study was to evaluate the feasibility of the AERx Pulmonary Delivery System for delivering nonviral gene therapy formulations to the lung. We found that "naked" DNA undergoes degradation following aerosolization through the AERx nozzle system. However, DNA formulated with a molar excess of cationic lipids (lipoplexes) showed no loss of integrity. In addition, the lipoplexes showed no significant change in particle size, zeta (zeta) potential, or degree of complexation following extrusion. The data suggest that complexation with cationic lipids had a protective effect on the formulation following extrusion. In addition, there was no significant change in the potency of the formulation as determined by a transfection study in A-549 cells in culture. We also found that DNA formulations prepared in lactose were aerosolized poorly. Significant improvements in aerosolization efficiency were seen when electrolytes such as NaCl were added to the formulation. In conclusion, the data suggest that delivery of lipoplexes using the AERx Pulmonary Delivery System may be a viable approach for pulmonary gene therapy.
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Affiliation(s)
- Deepa Deshpande
- Aradigm Corporation, 3929 Point Eden Way, Hayward, CA 94545, USA.
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Geller DE, Pitlick WH, Nardella PA, Tracewell WG, Ramsey BW. Pharmacokinetics and bioavailability of aerosolized tobramycin in cystic fibrosis. Chest 2002; 122:219-26. [PMID: 12114362 DOI: 10.1378/chest.122.1.219] [Citation(s) in RCA: 240] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To describe the pharmacokinetics and bioavailability of inhaled tobramycin (TOBI; Chiron Corporation; Seattle, WA), 300-mg dose, delivered by a nebulizer (PARI LC Plus; Pari Respiratory; Richmond, VA) and a compressor (Pulmo-Aide, model 5650D; DeVilbiss Health Care; Somerset, PA) in cystic fibrosis (CF) patients during the pivotal phase III trials. DESIGN Data from two identical, 24-week, randomized, double-blind, placebo-controlled, parallel-group studies. SETTING US sites randomized 258 patients with CF to receive tobramycin, 300 mg twice daily, in three 28-day on/28-day off treatment cycles. MEASUREMENT Tobramycin sputum concentrations were assessed 10 min after the first and last doses were administered in the 20-week study. Serum tobramycin concentrations were assessed before and 1 h after the first and last doses had been administered. The population estimate of the apparent clearance was used to estimate the bioavailability fraction. RESULTS The mean peak sputum concentration was 1,237 microg/g. About 95% of patients achieved sputum concentrations > 25 times the minimum inhibitory concentration of the Pseudomonas aeruginosa isolates. One hour after the dose, the mean serum concentration was 0.95 microg/mL. Tobramycin did not accumulate in the sputum or serum over the course of the study. Pharmacokinetic data were best represented by a two-compartment model with biexponential decay and slope estimates comparable to those following parenteral administration. The estimated systemic bioavailability after aerosol administration was 11.7% of the nominal dose. CONCLUSIONS The administration of tobramycin, 300 mg bid, in a 28-day off/28-day on regimen produced low serum tobramycin concentrations, reducing the potential for systemic toxicity. High sputum concentrations ensure efficacious antibiotic levels at the site of the infection. Inhaled tobramycin significantly improved the therapeutic ratio over that of parenteral aminoglycosides.
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Affiliation(s)
- David E Geller
- Nemours Children's Clinic, Division of Pulmonology, Orlando, FL 32806, USA.
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Abstract
Abnormal mucociliary clearance (MCC) is one of the central hypotheses for the development of lung disease in patients with cystic fibrosis (CF). However, attempts to demonstrate this decrease of MCC in vivo have proved to be somewhat less definitive, with the evidence barely favoring impaired clearance. Any apparent disparities are most likely due to the variety of methodologies used by different laboratories to measure MCC. The limitations of the various methodologies are examined in this review, in an attempt to better facilitate comparison of results. A number of physical and pharmacological therapies have been developed to promote mucus clearance from the CF airway. A summary of the results of interventional studies utilizing the measurement of MCC as an outcome measure is presented.
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Affiliation(s)
- Michael Robinson
- Cystic Fibrosis Centre (E11S), Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
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Smaldone GC. Radionuclide scanning, respiratory physiology, and pharmacokinetics. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2002; 14:135-7. [PMID: 11681645 DOI: 10.1089/08942680152484063] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lange CF, Hancock RE, Samuel J, Finlay WH. In vitro aerosol delivery and regional airway surface liquid concentration of a liposomal cationic peptide. J Pharm Sci 2001; 90:1647-57. [PMID: 11745723 DOI: 10.1002/jps.1115] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A liposome encapsulation was optimized for the entrapment and aerosol delivery of an alpha-helical cationic peptide, CM3, which had shown good antimicrobial and antiendotoxin activity in vitro. The encapsulation procedure and the phospholipids used were selected to maximize both the encapsulation and nebulization efficiencies, without compromising liposomal integrity during nebulization. The best compromise was found with dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol (3:1 molar ratio), which allowed for peptide encapsulation levels of 730 microg/mL using 30 mM lipid concentration. The aerosol produced with the selected liposomal formulation was subsequently analyzed for determination of size distribution and nebulizer efficiencies. These quantities were used as input for a mathematical lung deposition model, which predicted local lung depositions of the liposomal peptides for three models of lung geometry and breathing patterns: an adult, an 8-year-old child, and a 4-year-old child. The deposition results were then applied to a novel model of airway surface liquid in the lung to assess the concentration of the deposited peptide. The resulting concentration estimates indicate that the minimum inhibitory levels of CM3 can be reached over most part of the tracheobronchial region in the adult model, and can be exceeded throughout the same region in both pediatric model subjects, using a valved jet nebulizer with a 2.5mL volume fill.
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Affiliation(s)
- C F Lange
- Aerosol Research Laboratory of Alberta, Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada, T6G 2G8
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Smaldone GC. Deposition and clearance: unique problems in the proximal airways and oral cavity in the young and elderly. RESPIRATION PHYSIOLOGY 2001; 128:33-8. [PMID: 11535260 DOI: 10.1016/s0034-5687(01)00262-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prospective longitudinal studies measuring aerosol behavior in the respiratory tract as humans age have not been performed. The present paper reviews observations related to aging of the respiratory tract and other effects more likely due primarily to disease and iatrogenic causes. Upper airway deposition was found to approximate 50% in children during inhalation of drugs thought to be designed primarily for deposition in the lower respiratory tract. In older subjects, aging per se did not have a major impact on the deposition of aerosols. Disease processes that develop with age were shown to be the primary cause of deposition abnormalities. Flow-limitation in central airways was proposed as a major factor responsible for central airway deposition as well as abnormal clearance in common obstructive lung diseases. The oral cavity, a source of pathogenic organisms causing pneumonia, was also studied in the elderly. Salivary clearance, often abnormal in the aged, was related to colonization with pathogenic bacteria. Salivary clearance was not obviously reduced by aging per se but by iatrogenic sources such as drug therapy for other diseases.
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Affiliation(s)
- G C Smaldone
- Pulmonary/Critical Care Division, State University of New York at Stony Brook, HSC T17-040, Stony Brook, NY 11794-8172, USA.
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Diot P, Dequin PF, Rivoire B, Gagnadoux F, Faurisson F, Diot E, Boissinot E, Le Pape A, Palmer L, Lemarié E. Aerosols and anti-infectious agents. JOURNAL OF AEROSOL MEDICINE : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR AEROSOLS IN MEDICINE 2001; 14:55-64. [PMID: 11495486 DOI: 10.1089/08942680152007909] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Anti-infectious agents such as pentamidine, antibiotics (mainly colistine and aminoglycosides), and amphotericin B can be administered by aerosol. Apart from pentamidine and Tobi, this route of administration is not officially approved and it constitutes an empirical approach, which has benefited from recent research summarized hereafter. The most fundamental question is related to the potentially deleterious effects of nebulization processes, especially ultrasound, on the anti-infectious properties of the drugs. Colimycin, which was chosen as a reference because its polypeptide structure makes it unstable a priori, proved to be resistant to high frequency ultrasound, which is encouraging for other molecules such as aminoglycosides or betalactamins. The nebulizer characteristics also have to be taken into account. An aerosol can be produced from an amphotericin B suspension and from colistine using both an ultrasonic nebulizer and a jet nebulizer. Differentiating between good and bad nebulizers is not dependent upon the physical process involved to nebulize the drug, but on the intrinsic characteristics of the device and its performance with a known drug. The inhaled mass of an aerosol in the respirable range must be high and dosimetric nebulizers represent significant progress. Finally, administration of anti-infectious aerosols requires a new pharmacological approach to monitor treatment, and urinary assays are promising for this purpose.
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Affiliation(s)
- P Diot
- Groupe de Pneumologie et Imagerie de Ciblage, INSERM EMI-U 00-10, CHU Bretonneau, Tours, France.
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Dequin PF, Faurisson F, Lemarié E, Delatour F, Marchand S, Valat C, Boissinot E, de Gialluly C, Diot P. Urinary excretion reflects lung deposition of aminoglycoside aerosols in cystic fibrosis. Eur Respir J 2001; 18:316-22. [PMID: 11529290 DOI: 10.1183/09031936.01.99086801] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using nebulization to deliver aminoglycosides may be of benefit in cystic fibrosis (CF) patients colonized by Pseudomonas aeruginosa. However, one problem with this route is the absence of clinical parameters allowing estimation of the mass of drug deposited in the lungs (MDL). The aim of this study was to assess whether aminoglycoside excretion in the urine reflects the MDL. Fourteen studies were performed in seven CF patients. Amikacin was mixed with albumin labelled with 99mTc and nebulized with an ultrasonic nebulizer. The MDL was determined by the mass-balance technique. Urine was collected during the 24 h following inhalation and was assayed for amikacin by fluorescence polarization immunoassay (FPIA). The mean+/-SEM MDL was 14.0+/-2.2% of the nebulizer charge. The mean+/-SEM amount of amikacin excreted in the urine was 20.9+/-4.5 mg and correlated with the MDL (r=0.93; p=0.0001). There was, however, wide intersubject variability in both deposition and excretion in the urine. Monitoring excretion of aminoglycosides in the urine allows noninvasive estimation of the mass of drug deposited in the lung in cystic fibrosis patients, which might be useful to assess the dose-response relationship in groups of patients, but intersubject variability prevents its use for individual follow-up.
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Affiliation(s)
- P F Dequin
- Inserm EMI-U 00-10, University of Tours, Dept of Respiratory Diseases, Bretonneau University Hospital, France
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Abstract
STUDY OBJECTIVES To develop practical ways of nebulizing colistin by determining the rate of drug output, total drug output, and particle-size distribution of two commercially available jet nebulizers, the disposable Hudson 1730 Updraft II (Hudson Respiratory Care; Temecula, CA) and the reusable Pari LC Star breath-enhanced nebulizer (Pari Respiratory Equipment; Midlothian, VA). METHODS The nebulizers contained colistin, 75 mg, in 4 mL of isotonic solution. Particle-size distribution was measured by helium-neon laser diffraction, allowing calculation of the respirable fraction (RF), the mass of aerosol comprised of droplets < 5 microm. RESULTS The mean (95% confidence interval [CI]) total rate of output of the Updraft II was 2.6 mg/min (2.0, 3.1; n = 4) with 1.3 mg/min (1.0, 1.5) mg/min within the RF. The rate of output of the LC Star increased in a quadratic relationship to the inspiratory flow, delivering 1.8 mg/min (0.7, 2.0; n = 4) with 1.4 mg/min (1.3, 1.6) within the RF, and 6.2 mg/min (5.6, 6.8) with 5.3 mg/min (4.8, 5.7) within the RF, at 0 L/min and 20 L/min inspiratory flows, respectively. Efficiency, as the rate of expected pulmonary deposition divided by rate of total output, was then calculated. The LC Star estimated 56% (51, 61) efficiency, with pulmonary delivery of 29% (26, 32) of the charge of the nebulizer, compared to the Updraft II at 22% (22, 23) efficiency and expected pulmonary deposition of 10% (10, 10) of the dose. CONCLUSIONS Colistin can be successfully nebulized with both nebulizers tested. This study provides an estimate of in vivo efficiency and expected pulmonary deposition that may be used in future trials.
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Affiliation(s)
- S L Katz
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Canada
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